Non-Emergency Department (ED) Interventions to Reduce ED Utilization: a Scoping Review

Abstract

Background: Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. Methods: This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to January 2023. The inclusion criteria covered studies reporting on interventions outside the ED aimed at reducing ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and targeted population. Results: Among the 9,799 screened records, we included 139 studies, comprising 114 intervention studies and 25 systematic reviews. In the primary studies, care coordination/case management or other care programs were most commonly examined across 13 categories of interventions. The majority of interventions took place in clinics or medical centers, in patients' homes, or in primary care settings - and targeted patients with a specific medical conditions. Conclusion: A large number of studies have been published investigating interventions to mitigate the influx of patients to the EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is also needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.